Provider Demographics
NPI:1689767592
Name:LEFF, MERYL SUSAN (LCSW, CASAC, BCD)
Entity Type:Individual
Prefix:MRS
First Name:MERYL
Middle Name:SUSAN
Last Name:LEFF
Suffix:
Gender:F
Credentials:LCSW, CASAC, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W MAIN ST
Mailing Address - Street 2:SUITE 338
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-3012
Mailing Address - Country:US
Mailing Address - Phone:631-893-6355
Mailing Address - Fax:631-893-6355
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:SUITE 338
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-3012
Practice Address - Country:US
Practice Address - Phone:631-893-6355
Practice Address - Fax:631-893-6355
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10712101YA0400X
NYR049140-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2649282OtherAETNA PROVIDER ID
NY87726OtherUN. BEH. HEALTH PROV ID
NY131751OtherVYTRA PROVIDER ID
NY161543 MHSOtherVALUE OPTIONS PROVIDER ID
NY7480430OtherGHI PROVIDER ID
NYNX4021OtherBLUE CROSS PROVIDER ID
NY02116558Medicaid
NY1435082OtherCIGNA PROVIDER ID
NYP2559539OtherOXFORD PROVIDER ID
303899OtherMHN
NY42259POtherHIP PROVIDER ID
NYNG4821Medicare ID - Type UnspecifiedMEDICARE ID